NORWAY





Directives
Overordnet nasjonal helseog sosialberedskapsplan - Versjon 1.0 fastsatt 31. januar 2007 [NO]
	Som ledd i oppfølgingen av St. meld. nr. 37 (2004-2005 Flodbølgekatastrofen i Sør-Asia og sentral krisehåndtering, besluttet Helse- og omsorgsdepartementet å utarbeide en oversikt som gjengir hovedtrekkene i landets helse- og sosialberedskap. Hensikten med den overordnede planen er å synliggjøre hovedelementene i helse- og sosialsektorens beredskapsopplegg og sammenhengen mellom disse elementene. Overordnet nasjonal helse- og sosialberedskapsplan beskriver aktørene i helse- og sosialforvaltningen og helse- og sosialtjenesten ved krise- og katastrofesituasjoner og i planleggingsfasen. Beskrivelsen omfatter lovgrunnlag mv. aktørenes rolle og plassering i beredskapsorganisasjonen, ansvar, oppgaver og ressurser, samhandling og varslingsveier. Det gis også en kort framstilling av hvilke aktører internasjonalt som norske helsemyndigheter samhandler med i krisesituasjoner. Den overordnede planen bygger på de etablerte prinsippene for beredskapsarbeidet, både generelt og innad i sektoren, og introduserer ikke endrede forutsetninger eller ansvarsforhold.
Early Intervention Following Trauma [EN]
	Abstract People who experience traumatic incidents usually demand the following: early organised help that has an outreach focus and help that provides them with information regarding what has happened, what they can expect for the near future and about usual reactions. They want help for their children, and they want help that lasts over time. User involvement, partnership and informational exchange more than informational transfer will be part of trauma services in the future. Unfortunately within the mental health field a “myth” that early intervention is of little benefit and actually may harm people has been established. This is in sharp contrast to the needs expressed by traumatised people. Although the new “myth” with its resulting debate may help us to critically review the responses undertaken to help people following traumatic events, there is also the danger of “throwing the baby out with the bath-water”. In this presentation this “myth” will be challenged, and sensitive outreach efforts to help families facing trauma will illustrate the benefit of early intervention. However, it will be emphasised that early intervention needs to be well organised and contain more than just providing comfort and a chance to come together. The continuum of services must include immediate intervention, psycho educational intervention and more specific trauma therapy for those in need (...).
Early intervention – a family perspective [EN]
	Early intervention encompasses various efforts instigated to help people following a critical or traumatic event. It ranges from the comfort and care shown those who are admitted to hospital following an injury, to more structured forms of psychological support provided in group settings, such as "Critical Incident Stress Debriefings" (CISD) also called "Psychological debriefings". These interventions belong to the domain of "crisis intervention", aiming at reducing distress, stabilizing the situation, minimizing recovery time and restoring function in persons, families and communities. The interventions used vary from setting to setting, from more formalized programs to secure follow-up for emergency personnel that deal with critical situations on an almost daily basis (Critical Incident Stress Management – CISM – see Everly & Mitchell, 1997) to less structured interventions for people who suddenly and without any training are exposed to a traumatic event. Unfortunately "debriefing" has come to be a common denominator both for very brief early interventions and for more elaborate practices (...).
Expériences

Tsunamien – ettervirkninger for overlevende og pårørende [NO]
	26. desember 2004 rammet tsunamien mer enn ti land. Over 280 000 omkom, og mer enn en million ble hjemløse (1). Indonesia ble hardest rammet. De fleste norske som ble rammet, var i Thailand. Alle 84 nordmenn som omkom, ble funnet. Mange overlevde flodbølgen, men ble utsatt for betydelige påkjenninger. Et stort hjelpeapparat ble iverksatt for å hjelpe overlevende og pårørende og for å identifisere omkomne. Store katastrofer er sjeldne. Når de finner sted, er det imidlertid viktig å systematisere erfaringene. Hensikten med denne studien var å studere personer som ble direkte rammet av tsunamien (tatt av bølgen) og pårørende til mennesker som ble direkte rammet. Vi så på graden av traumatisering, symptomer på posttraumatisk stressforstyrrelse (PTSD), angst og depresjon og på funksjon det første året samt graden av tilfredshet med hjelpetiltak.
Back to Where It Happened: Self-Reported Symptom Improvement of Tsunami Survivors who Returned to the Disaster Area [EN]
	Background: During October and November 2005, the National Norwegian Tsunami Support Association organized a journey to the disaster area for survivors. The aim of this study was to investigate whether the Tsunami affected the participants’ psychological problems. Methods: Twenty-nine adults and 19 children made the journey. Steps were taken to enable each individual to acquire an overall understanding of the catastrophic event. Various forms of antiphobic training were provided. At the end of the stay, 28 adults replied to a questionnaire. The questions concerned: (1) motives for traveling; (2) benefits experienced; (3) psychological problems before departure; and (4) problems at the end of the stay. Parents with children were asked to assess their children’s psychological problems at the same points in time. Results: Considerable improvements in anxiety symptoms were reported and observed in both the adults and children.No certain cases of retraumatization occurred. Discussion: The improvements can be understood in the light of psychodynamic, cognitive, and behavioral theory approaches. The duration of the improvement in symptoms remains to be documented. There appears to be grounds for encouraging traumatized patients to return to a disaster area as part of the treatment process if they so wish.
The Göteborg discothèque fire, 1998 [EN]
	Findings from a study of 563 adolescents’ reactions following a discotheque fire that killed 63 young people in Göteborg in October 1998 are presented. The group answered a questionnaire seven months following the disaster. The questionnaire included the Impact of Event Scale (IES) and the Birleson Depression Self-Rating Scale (DSRS). The level of trauma was found to be very high, while depression scores were less elevated. A little under a third of the students scored above a clinical cut-off point (>35) on the IES, indicating high posttraumatic stress levels. Girls evidenced more depression and traumatic stress reactions than boys. Levels of reactions increased with more closeness (knowing victims personally) and if the adolescents were of non-Swedish origin.
A Maritime Disaster: Reactions and Follow-up [EN]
	ABSTRACT: In 1999, 69 people survived a maritime disaster on the Norwegian coast, during which 16 others died. Besides immediate psychosocial assistance, post-disaster intervention included psychological debriefings after one week, follow-up debriefing a month later, screening of those in need of individual help, and help for those returning to the scene of the disaster. The results of the psychometric tests showed that a considerable number of survivors scored above clinical cut-off points for extreme stress reactions. These results were compared with results from other studies of maritime disasters. Although the life threat and exposure in this disaster were extreme, the scores were lower than for the other studies, with one exception. The authors concluded the lower distress scores compared to other maritime disasters were probably impacted by the structured and caring system that was implemented to care for survivors. Almost all (93%) considered the debriefing meetings as helpful, and they were able to discriminate between different functions served by the meetings.
Assistance from local authorities versus survivors' needs for support after suicide [EN]
	As part of a larger study, this article describes the local authorities inNorway as providers of help and survivors as recipients of help after the suicide of a young person (<30 years) in 83 families. A questionnaire developed for this study maps the extent of professional community support as reported by parent survivors (N¼128). Additionally, 41survivors described the quality of the assistance through in-depth interviews. Another questionnaire assesses the provisions and the organization of intervention strategies in local communities. Personnel in 321ofNorway’s 481 municipalities responded. Although survivors’ wishes for ideal support coincide with recommendations by experts in the field, local authorities lack the organization to fulfill such expectations.The discussion highlights issues relating to content, organization, and ideology of the assistance.
Tsunamien: Berørte barn og deres familier [NO]
	26. desember 2004 førte et jordskjelv til at enorme flodbølger skylte inn over land i flere deler av Sørøst-Asia. Alle som befant seg i nærheten av vannet ble rammet, og ca. 230 000 mennesker døde. Flere som var på ferie, opplevde tsunamien på nært hold. Selv om de opplevde den samme flodbølgen, var likevel opplevelsene og konsekvensene for de enkelte familiene ulike. Nasjonalt kunnskapssenter om vold og traumatisk stress (NKVTS) fikk i 2005 i oppdrag av Sosial- og helsedirektoratet å undersøke hvilke konsekvenser tsunamien fikk for de berørte. Dette har resultert i flere delstudier gjennomført ved senteret. Denne rapporten presenterer resultater fra tre av studiene som fokuserte på barnefamilienes situasjon. Gjennom studiene kom vi nært inn på familier som led store tap og mange som hadde opplevd svært skremmende hendelser. Vi snakket med barn som fortalte om redselen for å dø, om skrekken de følte da de kom bort fra sine foreldre, og om mareritt som plaget dem da de kom hjem. Vi møtte også mange familier som var opptatt av at det var andre som hadde lidd større tap enn dem selv. Noen fortalte at de følte seg mer sårbare etter denne hendelsen. De hadde erfart at slike katastrofer rammer blindt, og mange strevde med å finne meningen med hendelsene. For mange hadde også erfaringene deres gitt dem nye perspektiver. Voksne snakket om hvordan de nå satte mer pris på livet. Ungdommene fortalte om en styrket tro på mennesker etter å ha blitt hjulpet av thailendere som selv hadde mistet alt de eide. De var blitt mer oppmerksomme på ulikheter i verden og de følte mer solidaritet med mennesker som lider i andre land (...).
Rammedes vureringer av oppfølging etter et jordskred [NO]
	Innledning Som ledd i oppfølgingen av St. meld. nr. 37 (2004-2005) Flodbølgekatastrofen i Sør-Asia og sentral krisehåndtering, besluttet Helse- og omsorgsdepartementet å utarbeide en oversikt som gjengir hovedtrekkene i landets helse- og sosialberedskap. Hensikten med den overordnede planen er å synliggjøre hovedelementene i helse- og sosialsektorens beredskapsopplegg og sammenhengen mellom disse elementene. Overordnet nasjonal helse- og sosialberedskapsplan beskriver aktørene i helse- og sosialforvaltningen og helse- og sosialtjenesten ved krise- og katastrofesituasjoner og i planleggingsfasen. Beskrivelsen omfatter lovgrunnlag mv. aktørenes rolle og plassering i beredskapsorganisasjonen, ansvar, oppgaver og ressurser, samhandling og varslingsveier. Det gis også en kort framstilling av hvilke aktører internasjonalt som norske helsemyndigheter samhandler med i krisesituasjoner. Den overordnede planen bygger på de etablerte prinsippene for beredskapsarbeidet, både generelt og innad i sektoren, og introduserer ikke endrede forutsetninger eller ansvarsforhold. Overordnet nasjonal helse- og sosialberedskapsplan er ikke et operativt planverk til bruk i en krisesituasjon. Alle aktører omtalt i den overordnede planen har egne beredskapsog kriseplaner som skal legges til grunn for krisehåndteringen. Dette dokumentet gir et helhetlig rammeverk som de enkelte aktørene kan relatere planverket for sin egen virksomhet til. Overordnet nasjonal helse- og sosialberedskapsplan vil bli ajourført årlig av Helse- og omsorgsdepartementet (...).
Psychological interventions in disasters – reflections from professional experience [EN]
	This article describes some of the challenges involved in early and long-term intervention to reduce distress and prevent chronic mental health problems. Psychological theory and practice are put to use in disaster intervention to a larger degree than before. Many of these disasters are crossnational and cross-cultural and pose complexities seldom met in more circumscribed national disasters. Over the last decade we have observed a steep increase in both UN (United Nations) and NGO (Non Governmental Organisations) interest and willingness to provide psychological and social, often termed psychosocial, support to affected groups. Not only is psychological theory and intervention used for direct victims, but for indirect victims and helpers. So universal has this response become, and so eager are all the organisations to show their presence following disasters, that this causes logistical problems. In some recent disasters the influx of counsellors, therapists and other psychosocial helpers and the lack of coordination of the psychosocial resources has taxed the organisational response and resources instigated to help affected groups.
Long-term collective assistance for the bereaved following a disaster: A Scandinavian approach [EN]
	Objective: This paper describes an approach where disaster-bereaved families gather over three weekends to process and learn about grief together (a collective approach). Method: The article is based on experience related to several disasters in Norway and Finland, using a maritime disaster in which 16 persons lost their lives as a case example. Conclusions: This approach provides an opportunity to help numerous persons simultaneously. It facilitates support, communality and help within a group setting, provides access to self-help methods and allows screening of those in need of further help. Three weekend gatherings were held during the first year following loss of family members. Using plenary sessions, small groups and rituals during weekends, important themes within normal grief reactions over time were addressed (...).